The format of MADtv is a mixture of scenes shot live for a studio audience, and pre-taped short filmsóboth place a heavy emphasis on pop culture parody. Skits and sketches are performed in a manner similar to other variety shows. In the first three seasons, animated segments based on Don Martin and Spy vs. Spy comic strips would be shown between sketches without the studio audience. Aside from the appearance of Alfred E. Neuman in the opening credits and during occasional interstititials, these cartoons provided the only direct connection between the magazine and the TV series. Indirectly, another connection is that relative to other sketch shows, MADtv has a heavy focus on parody. Music videos and TV shows are parodied often on MADtv.Previously, MADtv had opening and closing monologues from the cast. Recent seasons has monologues performed in character.

MADtv spoofs other shows, such as the long-running game show The Price is Right, with actors playing Bob Barker and Rod Roddy, and it also takes on other celebrities, like Wayne Brady, Kenny Rogers, and John Madden.One recurring skit is the show-within-a-show called Real **********ing Talk with Dollar Bill Montgomery, which is a spoof of other forum-style shows such as Hardball with Chris Matthews and Real Time with Bill Maher. Maher made a cameo appearance on a tenth-season episode, opposite cast lead Aries Spears. Real **********ing Talk is known for its excessive use of (censored) foul language